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34. -5 -72
BOX 15
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
W -12 -00
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheeVplan.
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Well Driller's Name MI U I L L I N G4 INC. Address:75 Putnam Ave., Brewster NY
Signature: tA MITIM A Date: 6/9/00
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
415 Farm to Market Rd.
Towtf/Village. " "` "
PATTERSON
Tia— Grid - #"
Map 34 Block 5 Lpt(s) 72
Well Owner:
Name: Address:
WAYNE & ANNE PEARSON, 415 Farm to Market R'd,, Brewster
Use of Well:
1- primary
2- secondary
x x Residential
Business
Industrial
Public Supply Air cond/heat pump Irrigation
Farm Test/monitoring Other(specify)
Institutional Standby
Drilling Equipment
Rotary
Cable percussion x x Compressed air percussion Other (specify)
Well Type
Screened
Open end casing x_ Open hole in bedrock Other
Casing Details
Total length 5-1 ft.
Length below grade 4 9__ft.
Diameter 6 in.
Weight per foot 17 lb /ft.
Materials: x x Steel Plastic _ Other
Joints: _ Welded � Threaded _ Other
Seal: _ Cement grout x x Bentonite Other
Drive shoe: x x Yes- - No
Liner: Yes No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed Pumped xx Compressed Air
Hours 6
Yield —2-0- gpm
Depth Data
Measure from land surface- static (specify ft)
50
During yield test(ft)
300
Depth of completed well in feet
365
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft. ;
Land surface
3
1 0- 3 4
T O s o i l
3
15
10 -3/4
Soft weathered ledge
_ _ 5._
_..._. 4 G
. _...
1 �O -3,j 4.
. Ke d i u m . to, hard . r. a nA t e.
40
2.00
6
6 -1/8
Hard granite
20
300
8
6-1/8
White quartz
30
360
20
6 -1/8
Grey. granite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
200
6
Pump Typ %ubmersi b(Tepacity 13
Depth .300 Model 11W041 2
Voltage 230 HP 2
Tank Type Di ragmVolume 86 gallon
300
8
365
2 0
Date Well Completed
6/7/00
Putnam County Certification No.
2
Date of Report
6/9/00
Well D (s nature)
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheeVplan.
r .. 1
Well Driller's Name MI U I L L I N G4 INC. Address:75 Putnam Ave., Brewster NY
Signature: tA MITIM A Date: 6/9/00
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller
Form WC -97
rim �._...,.._.�,_ .
ti.. ,. ..... .. ;... ,....
i
Ira»., ..... �N <, o. ... �. _ . . _.. __..- _ _ .. .. .. � .._ ..._ . _ ..._..,.._...� -� ,..-._ er ,... _. e, _.. __ _.. ,.. _._..... .__.. _. .. _ _ .. ._ _ .. .. ._. ... �._. ... .. .. ...���
NORTHEAST LABORATORY OF DANBURY
39' M1LL --PLAEN -RoAi3 = DANBURY, - CT - 06811 r: _ - = CT:Cert: PH -0404• -
(203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471
LABORATORY REPORT -- WATER SUPPLY TESTING
REPORT TO:
MILL DRILLING, INC.
75 PUTNAM AVENUE
BREWSTER, N.Y. 10509
SAMPLE SITE:
SAMPLING POINT:
SOURCE:
TREATMENT:
TEST PERFORMED
BACTERIAL:6 /27/2000
Total Coliform (Bacteria)
PHYSICALS:
6/27/2000 - Color
Odor
pH
6/27/2000 - Turbidity
CHEMISTRY:
Nitrite N
Nitrate N
._ ... Alkalinity
_....... - .. _..... Hardness
6/27/2000 - Iron
Manganese
ml = milliliter
* *Notification Level
Sodium
Lead
DATE SAMPLE COLLECTED: 6/7/2000 6/27/2000
T ME COLLECTED: 9:22 A.M. & 2:15 P.M.
COLLECTED BY: ROB MILL
DATE RECEIVED @ LAB: 6/7/2000 & 6/27/2000
TESTED BY: LAB# 11471
REPORT DATE: 6/28/2000
PEARSON, FARM TO MARKET, PATTERSON, N.Y.
WELL HEAD
WELL -NEW
NONE
RESULT:
0 per 100 ml
5
ND
7.46
0.70 NTUs
<0.005
mg/L as N
0.93
mg/L as N
.64.0..
mg/L
-102.0 .....
mg/L -
0.075
mg/L
0.060
mg/L
4.3 mg/L
0.003 mg/L
MAXIMUM CONTAMINANT LEVEL
0 per 100 ml
15
3 Units
no designated limit
5 NTUs
1 mg/L as N
10 mg/L as N
no designated limits
_ . ••no designated�limits - _
... ........
0.30 mg/L
0.30 mg/L
[Note: Combined Limit for Iron plus
Manganese = 0.50 mg/L]
20 mg/L **
0.015 * **
mg/L = milligrams per Liter r]D = none detected NTU=Urits
* "Action Level
RESULTS BASED ON SAMPLES SUBMITTED: 6n/2000 & 6/27/2000
SAMPLE, AS TESTED ABOVE: X or CkOT POTABLE
(PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
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Laboratory Director
*NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 e OUTSIDE CT: 800 - 654 -1230
IPUTNAM COUNTY Y DIEIPARTIViI]ENT OF HEALTH
DI VRSffG Y OF IENVRROIMENTCAL HEALTH SIERVffCIES
...AAPIPL)IC LL.
-..,_ ATI< ®IY ®I�1STII8U T A WATiE
please print or type PCHD Permit #
Weld Location:
Street Address: Town/Village Tax Grid #372400- 34 -5 -72
415 Farm to Market Road Patterson, NY Map Block Lot(s)
WeRR Owneir:
Name:
Address:
Wayne Pearson
415 Farm to Market Rd., Brewster, NY
Use of WeDh
xx Residential Public Supply Air /Cond/Heat Pump Irrigation
I -PR immauy
Business Farm Test/Monitoring Other (specify)
2- secondairy
Industrial Institutional Standby
Amount of Use
Yield Sought 5 gpm # People Served 4 Est. of Daily Usage _dal.
Reason ffoir
xx Replace Existing Supply Test/Observation Additional Supply
DARKag
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Low.PH. Very corrosive water. Low yield. Not cost efficient
for treatment.
for HDrffing
WeR Type
xx Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No xx
Is well located in a realty subdivision. Yes No xx
Name of subdivision n/a Lot No.
Water Well Contractor: tjiLL DRILLINGS INC. Address:75 Putnam .Ave, , Brewster, NY
Is Public Water Supply available to site? .................................. ............................... Yes No xx
Name of Public Water Supply: n / a TownfVillage
Distance to property from nearest water main: 'nla
Proposed well location & sources of contamination to, e pr vid on sepay4ke sheet/plan.
Date: - .4./.1..2/00. ... Applicant Signature: _ AIIY,91,�2 _
IPEP397 TO CONSTRUCT A\ WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION.- This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water te driller certified by Putnam
County. �, J PU
Date of Issue 6 Z 6V Permit
Date of Expiration O Title: _
IPeirmmit is Non- Trransffeir a>fDIl
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner;
�Av W
a c1
Orange copy - Well MI. r
Form WP -97
Street Town State Zip
PERSON IN CHARGE`
/4.
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Name and e
6t3
TYPE OF.FACILITY;
n
FINDINGS:
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Dear
APPENDIX IE
0% "IMMIUM-111i
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Date
RE: Department of Health Review of Proposed
Sewage Treatment System for Property
Name:
Address: t-Ae 6K
Town:
Tax Map 7Z
Please be advised that an application for a Construction Permit relative to the construction of a
sewage system and/or well proposed for the captioned property has been made to the Putnam County
Department of Health. Attached please find a copy of the latest site plan. ''
If you have any questions, concerns or information which may bear on the Health Department's
review of this application, you may call the Health Department at (914) 278 -6130.
Received By.
Address:
Tax Map #:
toC)L
�
August, 1999 � �'5 �
AppndxE
Verb
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25
APPENDIX E
Date
RE- Department of Health Review of Proposed
Sewage Treatment System for Property
Name:
Address: l' ,arum
Town.
Tax Map #: — 5 — 7Z
Dear a,
Please be advised that an application for a Construction Permit relative to the construction of a
sewage system and/or well proposed for the captioned property has been made to the Putnam County
Department of Health. Attached please find a copy of the latest site plan.
If you have any questions, concerns or information which may bear on the Health Department's
review of this application, you may call the Health Department at (914) 278 -6130.
L
Received By:
Address:
Tax Map #:
3 -� -- )0
August, 1999
AppndxE
Very truly /y rs,
B:
Y
Title: ULLO 11".INC.
7E KM4W AVENUE
NY �papg.111t
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OWNER: WAYNE PEARSON
415 Farm to Market Rd.
Brewster
NY 10509
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ARTESIAN WELL CONTRACTORS
Putnam Ave. Brewster, N.Y. 10509 19'141 279 -5041
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PUT NAM COUNTY DEPARTMENT OF HEALTH
H
C! Division of Environmental Health Services, Carmel, N. Y. 10512
t
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P- 61_1` -Scxc) CT
1 Town or Village
Located at FA-e4y` —fJ Section `71 ' 1 �O +' ( Block
Owner W b �i C'. �G —�� �'� Lot �d� /� `�' �" Job
Separate Sewerage System built by ICCJdI°_ f i Y 1C� �1 e�� Address
� u
Consisting of i0d<D Gal. Septic Tank �S lineal Feet X -2 width trench
it
Other requirements
Water Supply: Public Supply From
Private Supply .Qwiiied- By y� e `�AQAi✓ 'SEE:
Address
"
Building Type TA""' ` �ni-� -5 • No. of
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving the above premises were constructs?
attached), and in accordance with the standards, rules and regulations; plans
Date --• 7— o Certified by
Address , I
u M A. X0,5,,
Date Permit Issued
of the completed work (copies of which are
he Putnam County Department of Health.
P.E. R.A.
"+�
License No. —1 Z>-6
Any person occupying premises served by the above system(s) shall promptly to a su ! necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become 1 and void as soon as a public sanitary sewer becomes
,available and the approval of the private water supply shall become null abd void when 'a public water supply becomes available. Such approvals are
•«subject to modification or change when, in the judgment of the Commissioner of Health, suct cation, modification or change is necessary.
Date BY Title
,
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PUT NAM COUNTY DEPARTMENT OF HEALTH
H
C! Division of Environmental Health Services, Carmel, N. Y. 10512
t
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM P- 61_1` -Scxc) CT
1 Town or Village
Located at FA-e4y` —fJ Section `71 ' 1 �O +' ( Block
Owner W b �i C'. �G —�� �'� Lot �d� /� `�' �" Job
Separate Sewerage System built by ICCJdI°_ f i Y 1C� �1 e�� Address
� u
Consisting of i0d<D Gal. Septic Tank �S lineal Feet X -2 width trench
it
Other requirements
Water Supply: Public Supply From
Private Supply .Qwiiied- By y� e `�AQAi✓ 'SEE:
Address
"
Building Type TA""' ` �ni-� -5 • No. of
Has Erosion Control Been Completed?
I certify that the system(s) as listed serving the above premises were constructs?
attached), and in accordance with the standards, rules and regulations; plans
Date --• 7— o Certified by
Address , I
u M A. X0,5,,
Date Permit Issued
of the completed work (copies of which are
he Putnam County Department of Health.
P.E. R.A.
"+�
License No. —1 Z>-6
Any person occupying premises served by the above system(s) shall promptly to a su ! necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become 1 and void as soon as a public sanitary sewer becomes
,available and the approval of the private water supply shall become null abd void when 'a public water supply becomes available. Such approvals are
•«subject to modification or change when, in the judgment of the Commissioner of Health, suct cation, modification or change is necessary.
Date BY Title
,
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Municipality
Section
Block
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the.standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs :Wade by me to such system, except where the failure
to operate properly is caused by the willful or negligent act'of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this /U day of /'U 198"/, Signa ure!
Title R MAYES CONS CO., INC..
If corpcBRffM ROAftve name
and PI4, N, Y, 12570
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
RECEIVED'
MAR 2 91992
PUTNAM COUNTY
DEPT. OF HER'''
Owner or
. _
urc
Purchaser
.
o Building
. P-:-.9 .r
Building �i""ding Constructed
-
by
Location - Street
a ov4 Ld..
Municipality
Section
Block
Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the.standards, rules and regulations of the Putnam
County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs :Wade by me to such system, except where the failure
to operate properly is caused by the willful or negligent act'of the occu-
pant of the building utilizing the system.
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing the system.
Dated this /U day of /'U 198"/, Signa ure!
Title R MAYES CONS CO., INC..
If corpcBRffM ROAftve name
and PI4, N, Y, 12570
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
RECEIVED'
MAR 2 91992
PUTNAM COUNTY
DEPT. OF HER'''
WATER dst7AIYffiU0
BACTERIOLOGICAL. EXAMNA71ON
Colifor'm* Couat, NF Method :
® dear 100 nd.
This veladlt iwdicetel the iearce of the wiplo was
of 'ratlllcgORjt laoddrq- Q&f4liejf wh.W , ok-0 f"Ar Wei collected.
P
April 18o 1.981
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MAR 2 91982
PUtKAr; 2c aEJ v
0�0 f. 6 F HEAL B e
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed. by well driller and submitted to County Health Department together with laboratory report of
- ro analysis,afmater- saTnple indicating water is-of satisfactory bacterial quality before certificate'of -construction compliance is" issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Wayne Pearson
ADDRESS
Farm to Market Rd., Patterson, NY 12563
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
SAME
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ E TABLISHMENT FARM ❑ TEST WELL
11 SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ ((SSpe ify)
DRILLING
EQUIPMENT
X COMPRESSED CABLE OTHER
ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH (feet)
DIAMETER (inches)
WEIGHT PER FOOT
❑ THREADED ❑ WELDED
rIE SHOE
YES ❑ NO
CrA3Rf7G
YES
NO
YIELD TEST
65 8
11 BAILED E] PUMPED ❑ COMPRESSED AIR HOUR G.P.M.
2
YIELD (G .J
81
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST [feet)
Depth of Completed Well '
in feet below Land surface: 1019
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (leet) I
TO (lest)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
R
MAR 2 9 79E2
PUrNA M COU
DEPT, PV - Y
OF
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
DATE OF REPORT
March 1 5,
WELL DRILLER a e)
982
Address
Other Requirements
:1 represent that "ll am wholly completely 4o
y
abo . ve-describled will rutted -as:shown-on the approv
placC !on,
tance 61 t
f.
ti Date 1F_
APPROVEDFOR CONSTAUi APPROVE_ or may be
Date
cn
ie de,
amei
eoVe
I
will':
approved pl i and -that ,said � fi w begins
we
Signed*'_
N.:. - I
on hi em(s),; -1) that the separate - sewage , disposal system'
in& standards rules and regulations o e Putnam
tisfactory,to the di)mmissl6ner of Healthwill
it:
r: assign
s 'PY ihe:bj4 Ilder; -that, said builder .,W I
two s imniediately4ollow.ing the date -of the isiu,
a th to 2).,that the drilled well described above
sta air 'rltilesrand regu7IkTl`3R79f the Putnam
P, F:
Llcense No.
V6 of the 66ildirill,-has been undertaken and is
ith-.' Any tha I n'g . e or . alteration i - on of construction . .
_;MI::I65 T' E bF HEALA�,
UN
V.
-�A fidsh� 4 Envrronmenial -Health Services,
i,
5� . .. ... .
CONSTR CT -PERMiT F0 _9EW*iG4�:PIISP0SAL SYSTEM -; P,
F_t 42
e�'S
a.
,Town oFQI
Locatetl Tax- "Map
�@lock,
Subdivision
Job,
Addre ss
Qwndir
Building Type
Number of Bedrooms — ''Design •Flow
are Feet
L
t : .al. Septic T4pk-. apd.,"-.i�
Separate Sewerage Syst6m, o
pa' 0 c,
be constructed by To on
V --Z
�ater..Su ubliF.I�:Mppi7y,
pply�: p ',Fiorn - -
i;s
P 64,
Private- ;Supply rivi
Address
Other Requirements
:1 represent that "ll am wholly completely 4o
y
abo . ve-describled will rutted -as:shown-on the approv
placC !on,
tance 61 t
f.
ti Date 1F_
APPROVEDFOR CONSTAUi APPROVE_ or may be
Date
cn
ie de,
amei
eoVe
I
will':
approved pl i and -that ,said � fi w begins
we
Signed*'_
N.:. - I
on hi em(s),; -1) that the separate - sewage , disposal system'
in& standards rules and regulations o e Putnam
tisfactory,to the di)mmissl6ner of Healthwill
it:
r: assign
s 'PY ihe:bj4 Ilder; -that, said builder .,W I
two s imniediately4ollow.ing the date -of the isiu,
a th to 2).,that the drilled well described above
sta air 'rltilesrand regu7IkTl`3R79f the Putnam
P, F:
Llcense No.
V6 of the 66ildirill,-has been undertaken and is
ith-.' Any tha I n'g . e or . alteration i - on of construction . .
*i
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. J
Owner WA(,j j)e C. Pj__e_C N) � Address ��►� ! c7:JST�� �vl
Located at ( Street fA"l � �tAV --T' CD -See. Block Lot ?AA .
�TH- ica e nearest cross s ree
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse Depth to Water Water Level
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
1 To
1 a 2-1
-2-t
o 1
7- �
5
�
2
q "
Z(4,
ZI
3
U
3 �g
10'Z
2 -
4
5
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Notes: 1) Tuts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 8 HOLE NO. HOLE NO.
®.
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INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED----
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY }�:�a E°sz . Date 1?--5I
- DESIGN
'Soil "Drop: S.D. Usable Are cc�o
No. of Bedrooms 3 Septic Tank Capacit A.
Absorption Area Provided By.li,," .F.x24" �� ggt-- r c
name 'V J( LL i A of A . L (Z�A bignature
Address 'PO. &.)K - S L �
cep 421 8
p��FfSSIosxP
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by Date
t
Wayne & Anne Pearson
Farm to Market Road
Brewster, NY 10509
Dear Mr. & Mrs. Pearson:
JOHN KARELL Jr., P.E., M.S.
„Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
March 8, 1993
Re: Proposed addition - Pearson, Farm to Market Rd.
(T) Patterson TM #34 -5 -72
I have received and reviewed the plans for the proposed addition to the above mentioned
residence.
The plans indicate that a 25' 6" x 16' addition will be added consisting of a family room,
enlarged kitchen and bathroom.
The survey indicates that sufficient area exists to expand or repair the sewage disposal
system, should it become necessary in the future. Therefore, based on the information
submitted, the above mentioned addition is APPROVED with the following conditions:
1. The total number of bedrooms must remain at 3 without prior approval by this
Department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained. ' ' "
3. All plumbing fixtures must be replaced or updated with water saving devices, i.e., low
flush toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. Any other permits or variances required are
the responsibility of the applicant and the jurisdiction of the Town of Patterson.
If you have any questions, please contact me at your convenience.
Very truly your
William Hedges
Sr. Public Hsalth Sanitarian
WH /jp
cc: BI (T) Patterson
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